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Pancreas divisum

Epidemiology

It is most common variation of pancreatic duct formation and may be present in ~4-10 % of the general population 3-4,6. It's MRCP prevalence is at around 9% with autospy prevalence going up to 14% 7.

Clinical presentation

Most people with a pancreas divisum are asymptomatic but it is more frequently found in patients with chronic abdominal pain and idiopathic pancreatitis than in the general population 4.

Pathology

It results from failure of fusion of dorsal and ventral pancreatic anlages. As a result, the dorsal pancreatic duct drains most of the pancreatic glandular parenchyma via the minor papilla. Although controversial, this variant is considered as a cause of pancreatitis.

Pancreatic divisum can result in a santorinicoele, which is a cystic dilatation of the distal dorsal duct, immediately proximal to the minor papilla.

Three subtypes are known:

type 1 (classic): no connection at all; occurs in the majority of cases: 70%